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ObjectivesTo conduct a pilot trial of a primary care Symptoms Clinic for patients with medically unexplained symptoms and evaluate recruitment and retention, and acceptability of the intervention and to estimate potential treatment effects for a full trial.Trial designRandomised parallel group pilot trial.SettingPrimary care in one locality.ParticipantsPrimary care database and postal questionnaire were used to identify patients with multiple specialist referrals and multiple physical symptoms unlikely to be explained by disease.InterventionsGeneral practitioner (GP) with special interest ‘Symptoms Clinic’ + usual care versus usual care alone. The Symptoms Clinic comprised one long (1 h) and three short (20 min) appointments.OutcomesNumber of patients identified and recruited; acceptability of the intervention (items from Client Satisfaction Questionnaire and interview); Medical Outcomes Survey Short Form 12 (SF-12) physical component summary.RandomisationAutomated blocked randomisation accessed by telephone.BlindingNone.Numbers randomized16 to intervention and 16 to usual care alone.Recruitment72 patients, from seven GP practices, had repeated specialist referrals and a Patient Health Questionnaire (PHQ)-15 score of ≥10 indicating a high probability of medically unexplained symptoms. 15 were ineligible and 25 declined to participate.Numbers analysed26 patients; two patients randomised to the intervention group were incorrectly included, three patients in the intervention group and one control did not complete outcome measures.OutcomeMost patients randomised to the Symptoms Clinic found the intervention acceptable: eight out of 11 reported the intervention helped them to deal with their problems. The mean difference between groups in SF-12 physical component summary, adjusted for baseline, was 3.8 points (SD 6).HarmsNo observed harms.ConclusionsPatients with multiple medically unexplained symptoms can be systematically identified in primary care; a randomised trial comparing the Symptoms Clinic with usual care is feasible and has the potential to show clinically meaningful benefit.Trial registrationISRCTN63083469.

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Background Email communication is established in business, science and education. Email dialogue between healthcare professionals is common practice, but email dialogue between patients and healthcare professionals is a new area. Government policy is to promote better patient access to healthcare professionals. There will be a relentless pressure on practices to respond to patient demand for email access for booking appointments, ordering prescriptions and asking for advice. 1-3 There are a number of arguments for an email dialogue between patients and professionals: • convenience • an exact record of dialogue is kept • asynchronous communication is possible • attachments with web-links can be used to disseminate information • opportunities to save unnecessary face-to-face contacts

Innovations in scientific and medical technologies,